Showing posts with label therapy. Show all posts
Showing posts with label therapy. Show all posts

What I would love to see written about EDs

I've seen two publications that have written about progress in two other areas of mental health: OCD and drug addiction. And I hope that this progress is translated into the world of eating disorders.

One is from a publication I received at the Society for Neuroscience Annual Conference from the National Institute on Drug Abuse. It's their latest booklet called "Drugs, Brain, and Behavior: The Science of Addiction" and the image on one of the first pages is this:


Granted, Tom Insel at the National Institutes on Mental Health said as much. But to have it in a handout, a little brochure, the most basic reading material on the subject: that we don't have. I hear a lot more now about how eating disorders are illnesses, not choices- which is good. I just love how in this brochure on addiction, they're not only brain diseases, but treatable ones.

Which is something we can't hear enough.

The other is from a site on OCD, tracing the history of OCD treatment from Freud to current day.

[Freud's] treatment of choice was psychoanalysis, and this was the accepted treatment of the disorder for many decades. Because this approach was met with no success, OCD was considered a rare and intractable disorder...

...Modern psychodynamic treatments, while having similar insight-oriented approaches, involve a more interactive approach by the therapist, with short-term therapy usually being less than 25 sessions. People who suffer from OCD usually have at least some insight into their behaviors, making the ultimate goal of insight less useful; insight alone is not enough to "cure" OCD. We now understand that OCD has, in large part, a biological causation (meaning, for example, that OCD behavior is not simply caused by a bad relationship with your mother), and it tends to run in families. Because of the failure of traditional psychological treatments for OCD, cognitive-behavioral treatments are now used in the treatment of the disorder, with very high rates of success.

Of course, CBT isn't the be-all or end-all of eating disorder treatment, firstly because you have to treat the malnutrition before CBT can really be effective. However, the history of OCD treatment, from an intractable illness to one with a relatively high rate of success, will one day parallel eating disorder treatment.
What do YOU hope will one day be written about eating disorders?

Back to therapy

Now that I've been moved in for about six weeks, I've started back to therapy. This break over the summer (due to 13+ hour days) is the longest I've gone since I was diagnosed. In some sense, it was a nice break. I get tired of talking about my crap with people so much, and having it usually followed with obvious statements:

You mean- I'm a perfectionist? Holy leaping lizards, Scooby!

After much searching, I finally found someone who a) wasn't going to pin everything on my mother, b) had office hours that were convenient (I couldn't find anyone with evening/weekend hours!), and c) had some chance of being partly reimbursed by my insurance. K is very nice, and I like her, and all is going well after two sessions.

Is my therapy focused on the eating disorder? Somewhat. K does specialize in eating disorders and no, I am NOT fully recovered. So yes, the topic comes up regularly.

On the other hand, I don't know if I'm in therapy for my eating disorder. I'm there to deal with all of the crap that primed me so perfectly to get sick in the first place. Anxiety. Perfectionism. Depression. Emotional lability. Inflexibility. (Lack of) stress management. Feelings of inadequacy. Social issues. Identity issues. And many of those have been amplified by being sick for so long. How do you function in this world as a person without an eating disorder (or other severe mental illness) when you can't really remember much else?

I suppose that's what I'm trying to learn here.

Being weight restored and stable and in recovery means that I can actually address these issues. I'm not always in crisis mode, trying to find ways to stay out of the hospital or try and eat more. And my brain is recovered enough that it can begin to process these things.

I guess we'll see what happens.

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Alternative therapies

I'm a veteran of therapy. I've been seeing a counselor/dietitian/etc pretty much weekly for the past 7.5 years. I know a whole freaking LOT about therapy.

I've talked about my problems. I've thought and thought about how my parents might have screwed me up, of my fears about growing up. I've tried how to change my thoughts. I've tried to change my behaviors. I've set goals. I've learned to tolerate my emotions. To ask for what I need.

And sometimes, that isn't the best kind of therapy.

When you leave the apartment at 6:45 am and don't get back until 8:30 pm because of multiple transportation snafus, talking isn't going to cut it.

I highly recommend loud angry music, several reruns of Grey's Anatomy on DVD with a big bag of microwave popcorn and scrubbing out the sink to deal with anger (and a boatload of dirty dishes).

And an early bedtime.

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Skill Building

It's cold and rainy and windy out- my apartment building is creaking and groaning.

I need a cup of hot tea to make this right.

I'm kind of getting (kind of) how powerful yesterday's realization was. I feel skillful- I knew what I had to do and I did it. This is not to say that I felt good or happy or stuff like that. Just...skillful.

As far as I've come in recovery, when Ed starts yelling like that, I usually give in. I don't know how to tolerate the anxiety that comes with eating when every fiber of my being is telling me to not eat. This is so conflicting, because on the one hand, I realize that it's somehow wrong (as in contrary, not wrong in a moral sense) to skip meals and snacks, and yet it seems wrong to actually eat.

And I don't know how to explain this to people.

This is why I still have my old meal plan stuck to my fridge. I know what I need to eat. It's right there on the paper.

Another one of my motivators is my New Zealand trip. Obviously, there's the trip itself, but that's not always enough. What adds to that, though, is how much I've paid for the trip. I'm, how shall we say, frugal (cheap, stingy- take your pick) and I do NOT want to waste all of this money. There are several ways the money could be wasted: I could get too sick to go or I would still go but be completely and utterly miserable and obsessing about food. Which seems to be the more egregious sin in my book.

The mentality of "I'm going to enjoy this bloody trip whether I want to or not!" is kind of odd, but it does work.

Letting myself hate eating also helps. That I can eat even though I don't want to. Even though my brain is telling me not to, that I'll become obese and die a miserable death only after living a miserable life. Guess what? These feelings won't kill me*. The eating disorder will.

There are still days when I'm not all gung-ho about recovery, even days when I'd rather go back to starving and purging and overexercise. It's real. Those feelings are still very, very real. And my turning point was that I could still have those feelings and still do what I needed to do in order to recover.

This is sounding far more chipper than I intended it. I don't want to be a downer, and didn't intend for this post to be depressing in the slightest. Things aren't perfect. But I do feel better about what went down last night.

That's it.

*Yeah, I know. It's easy to say this now when I'm not in front of a plate of fatty food. But it's still good to remind myself.

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Confusing therapy and therapeutic

This is something that has been making me think a little bit. Many treatment facilities use a wide range of "therapies" to combat a person's eating disorder. Now, really, the more ammunition, the better. I have no fear of the use-a-sledgehammer-to-kill-a-fly approach, because Ed is one hell of a big fly. So let's bring in the big guns, shall we?


However, I'm wondering whether these modalities are really therapy or merely therapeutic. To me, therapy is learning specific skills to deal with life in a more effective manner. Although the skills may or may not be measurable, they should be (reasonably) specific. Not just "Tell me about your mother." Talking about your past and identifying patters will probably be a part of therapy. It's important to know where you're coming from, and I think personal insight can be invaluable.


Take equine therapy. Horsies can be fun. I'm not the type of girl who likes a large animal taking a crap on her foot, but I've been trail riding, it was fun, etc. That being said, this trail-riding wasn't therapy. It was therapeutic, yes, but not therapy. I learned skills- namely how not to get bucked off the horse- and enjoyed the scenery, but these things didn't really help me recover from anorexia. It's the same thing for art and music. I love photography and making collages. I love to bead and crochet. Learning that I could use crochet to calm my anxiety was something that happened in therapy; but yarn therapy isn't out there yet. It's not therapy.


What is therapy? I like behavioral therapy. My old therapist always told me "Feelings chase behaviors." The only way I might want to eat in the future was to start eating NOW. Therfore, meals are therapy. You can't really change your thoughts unless you change your behaviors. My first therapist (with whom I have learned much, but also had a multitide of issues) thought that if I could identify why I was restricting or purging or overexercising, then I would stop.


Problem was, there usually wasn't a reason why. And knowing your motivations doesn't necessarily bring about change. I needed to learn how to deal with anxiety and anger and fear in order to move forward.


So is psychotherapy actually therapy? Technically, yes. But I'm not entirely sure that it is, or rather that hving someone to talk to every week is therapeutic. There's a difference, I guess. Wikipedia defines psychotherapy as: The treatment of people diagnosed with mental and emotional disorders using dialogue and a variety of communication techniques.


Ah, the definition says it all: treatment not therapy. I know the actual word "psychotherapy" does contain the word "therapy" but that doesn't mean it is. Freud was without a doubt revolutionary and did bring a lot to the field of psychology. But still...a cigar is just a cigar.


Doing all of my creative stuff helps me in my recovery. Beyond a reasonable doubt. It helps relieve stress, and provides motivation to keep on going in recovery. Learning how to use my creativity in a positive way was therapy- it was a skill, it could be defined. Eating regularly? Therapy. Making a scarf? Therapeutic. Bitching to my therapist? Therapeutic. Learning what I could do about the situation instead of just bitching about it? Therapy.


Treatment centers get some pretty big bucks for providing all of this therapy. Most of it doesn't hurt. I don't think these places are deliberately sucking money from your wallet. However naive I might be, I do tend to believe the best about people until I know better. Yet I'm also not dumb enough to believe that they're perfectly happy to charge more because they think that you think that riding a horsey is going to cure you of your eating disorder. They probably think it will. And treatment shouldn't be like prison, either. Therapeutic venues are important. But they're not therapy.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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Have any questions or comments about this blog? Feel free to email me at carrie@edbites.com



nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote



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